Tuesday, February 22, 2011

From reference 4 with various projected trajectories for UK liver death rates over next 25 years. EU=European Union.

The United Kingdom has more deaths every year attributed to liver disease than the Netherlands, Sweden, Norway, Australia, and New Zealand. All of the listed countries share a common background as far as genetics, culture, and drinking habits; yet, for having poor policies when it comes to alcohol the United Kingdom has a much higher death toll that can be linked to addiction. The downward spiral began in the mid 1980's, where up until that time all of those sister countries including the U.K. had similar death rates due to liver disease. While the other countries have had reductions in liver deaths the UK has seen a doubling of its liver death rate from 4.9 per 100,000 population to 11.4. While there will always be alcoholics in every country, some experts believe that if appropriate policies are enacted then the U.K could lower its death toll and lives might be saved. A comment published Online First by The Lancet, the thousands of lives lost every year in the U.K. are discussed by three experts, including Royal College of Physicians Past President Ian Gilmore; they believe that if action is taken deaths from liver disease can be avoided.

The goal is to get the U.K. in line with other European countries whose death tolls from liver disease are much lower. The authors (Gilmore, Nick Sheron, University of Southampton, UK, and Chris Hawkey, Queen's Medical Centre, University Hospital, Nottingham, UK) look at several projected scenarios in which the UK follows its current projection to a worst case scenario in 2019, or how it can change alcohol policies through and through and become more like France who have seen a huge decrease in liver death rates over the past few decades. Implemented properly, in time the U.K. over the next decade would be back in line with Australia, New Zealand, etc.

Their findings:

Using the Office of National Statistics figure for alcohol-related liver deaths in 2008 as the baseline, by 2019 the green (best case) scenario reaches the target (2500 deaths each year) with 22 000 fewer liver deaths in total by 2019

Over 20 years, the difference between black and green scenarios would be 77 000 liver deaths (80% under age 65).

Taking the wider harms of alcohol into account, (health problems other than liver deaths) conservative estimate of the difference between black and green scenarios probably amounts to between 160 000 and 250 000 lives lost or saved over a 20-year period in England and Wales.

They look to regulation-based activity that has helped control UK alcohol consumption in the past, and say: "These and other data show the influence of price and indicate that the regulation of population-level alcohol consumption is a duty of responsible government." The French forced an increase in alcohol quality which drove up the price cutting cheap alcohol producers out of the market which has helped lower liver disease. "Currently the UK drink producers and retailers are reliant on people risking their health to provide profits: figures from the Department of Health show that three-quarters of the alcohol sold in the UK is consumed by hazardous and harmful drinkers."

The authors highlight a number of things about current UK policy:

They support the current UK coalition government's intention to maintain the 2% above inflation duty escalator for the time being,

other recent announcements give cause for concern about their commitment to use the lever of price. Plans to ban the sale of alcohol beverages below cost (duty plus value added tax) and to increase duty on beer over 7•5% strength are inconsequential because of the tiny fraction of sales that fall into either category.

They are concerned about the involvement of private commercial companies such as ASDA and Tesco and Diageo in the Responsibility Deal Board chaired by the UK Health Secretary. (This board was set up with no specific representation from alcohol health experts. Since the paper was accepted the UK Government has allowed a health representative (Mark Bellis) to co-chair the Responsibility Deal Alcohol Network, as a result Dr Bellis also attends the RD Board)

"Irrespective of the means the UK Government chooses to design and implement their public health strategy, the key test must be the impact on hard outcomes. We have seen a change of emphasis from setting targets for process measures to outcomes measures, an approach quintessentially applicable to alcohol. Alongside debates on the effectiveness of individual measures, an outcomes framework should be created that establishes the level of liver mortality that the UK aspires to achieve."